Form S-12 UC Case Review - UC Path Version

UC Case Review (Form S-12)
Data Entry Window

UC Case Review Page – Basic Information Tab

[PHOTO]

OMB 0970-0553 [valid through MM/DD/YYYY]
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to document new information obtained after completion of the UC Assessment. Public reporting burden for this collection
of information is estimated to average 2 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Homeland Security
Act, 6 U.S.C. 279). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you
have any comments on this collection of information please contact UCPolicy@acf.hhs.gov.
UC-S-12 [Rev. MM/DD/YYYY]

UC Case Review Page – Relationships Tab

OMB 0970-0553 [valid through MM/DD/YYYY]
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to document new information obtained after completion of the UC Assessment. Public reporting burden for this collection
of information is estimated to average 2 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Homeland Security
Act, 6 U.S.C. 279). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you
have any comments on this collection of information please contact UCPolicy@acf.hhs.gov.
UC-S-12 [Rev. MM/DD/YYYY]

Adult Contact Relationships Data Entry Window

UC Case Review Page – Criminal Tab

OMB 0970-0553 [valid through MM/DD/YYYY]
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to document new information obtained after completion of the UC Assessment. Public reporting burden for this collection
of information is estimated to average 2 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Homeland Security
Act, 6 U.S.C. 279). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you
have any comments on this collection of information please contact UCPolicy@acf.hhs.gov.
UC-S-12 [Rev. MM/DD/YYYY]

Criminal Charges Date Entry Window

UC Case Review Page – Trafficking Tab

OMB 0970-0553 [valid through MM/DD/YYYY]
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to document new information obtained after completion of the UC Assessment. Public reporting burden for this collection
of information is estimated to average 2 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Homeland Security
Act, 6 U.S.C. 279). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you
have any comments on this collection of information please contact UCPolicy@acf.hhs.gov.
UC-S-12 [Rev. MM/DD/YYYY]

UC Case Review Page – TVRPA Tab

OMB 0970-0553 [valid through MM/DD/YYYY]
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to document new information obtained after completion of the UC Assessment. Public reporting burden for this collection
of information is estimated to average 2 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Homeland Security
Act, 6 U.S.C. 279). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you
have any comments on this collection of information please contact UCPolicy@acf.hhs.gov.
UC-S-12 [Rev. MM/DD/YYYY]

UC Case Review Page – Documents Tab

OMB 0970-0553 [valid through MM/DD/YYYY]
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to document new information obtained after completion of the UC Assessment. Public reporting burden for this collection
of information is estimated to average 2 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Homeland Security
Act, 6 U.S.C. 279). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you
have any comments on this collection of information please contact UCPolicy@acf.hhs.gov.
UC-S-12 [Rev. MM/DD/YYYY]

Documents Data Entry Window

UC Case Review Page – Certification Tab

OMB 0970-0553 [valid through MM/DD/YYYY]
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to document new information obtained after completion of the UC Assessment. Public reporting burden for this collection
of information is estimated to average 2 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Homeland Security
Act, 6 U.S.C. 279). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you
have any comments on this collection of information please contact UCPolicy@acf.hhs.gov.
UC-S-12 [Rev. MM/DD/YYYY]